HomeMy WebLinkAboutVasilakos, Van SOJn- LD VIASTEWfTER DI SPC6AL PERM T
CCNSTRU f I CN CR ALTERATI CN PERM T
SEPTI C TAN< or CESSPOOL
Per ni t Nb. 4186 R Resi dent i al X Nbn-Fbsi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSI ED TO
Nam : PECCN C CESSPCCL
Address 1: P O BCS( 487
City St Zip LPDREL NY 11948
Dascr i pt on of Pr oposed Const r uct i on or Al t er at i on
ADDI TI CN TO EXI STI NG SYSTEM
APPROdED AS SLUM TIED NAI NTAI N RECU FED SETBACKS FROM ADJACENT"
V'ELLS, BU LEI NGS, PROPERTY LI NES AND VIATER BC01 ES.
EXCAVATI CN I NSPECTI CN FEW FED
Name CF Owner VAN VAST LAKCS
Mai I i ng Address 1 2755 VESTM EW DR VE
Ci t y St Zi p NATTI TUCK NY 11952
Property Address 1 2755 VESTM EW DR VE
0 t y St Zi p IVATTI TUCK NY 11952
Tax Map ND. section 107. 00 bl ock 8 I of 7. 000
Cr oss St r eet M4YFLCV'ER RO14D
Bui I di ng Per ni t Number Cr oss Ref er ence:
Issue Date: 2/21/ 14 Elizabeth A Nevi I I e
Sout hol d Tow d er k
Of �40g)FFOLt�;
ELIZABETH A.NEVILLE,MMC �����4 Town Hall, 53095 Main Road
TOWN CLERK ; P.O.Box 1179
ca 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ��
O � � Fax(631)765-6145
MARRIAGE OFFICER y ��
RECORDS MANAGEMENT OFFICER .?Q( , -0„ 0 www.soutne oldt nny.gov
FREEDOM OF INFORMATION OFFICER — �'� www•southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
J a N 2 1 2014
DATED: January 21, 2014
Transmitted herewith is a copy of application No. 4186 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Van Vasilakos
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me. Thank you
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature a/
✓z� /
e/A-9A/
Dated
•
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•
ELIZABETH A.NEVILLE '4h�O o4 Town Hall, 53095 Main Road
i
TOWN CLERK 2 ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER : G �1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER O0'.° Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `.- " ',.'� southoldtown.northfork.net
.....•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V or Non-Residential @$25 Application No. 9 I S 64
Permit No. y *FP
PECONIC CESSPOOL
Applicant Name PO BOX 487
Applicant Mailing Address LAUREL NY 11948
Septic Tank or Cesspool V
Brief Desc '• '•ti : o os Construction or terat' n n
// �� C-e e�1eI---
Location of Proposed Construc ' n/Alteratio r
Owner of Property QM (ja SiIQ/1OS
Owner Mailing Address:
Owner Property Address: OZv
/ .;LC NY
/1P'97"?
Name and phone number of contact person Lf/)t '//� -034
Tax Map No: Section I b 7 Block g Lot
Cross Street illAyAkfOr
NOTE: LOCATION MAMUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAL EPARTME OV
ci ,
/ ce° *
Si a e of App cant Date
Received by:
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